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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364842823
Report Date: 10/29/2024
Date Signed: 10/29/2024 11:38:38 AM

Document Has Been Signed on 10/29/2024 11:38 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:GOMEZ FAMILY CHILD CAREFACILITY NUMBER:
364842823
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
10/29/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Ruth Gomez, Licensee TIME VISIT/
INSPECTION COMPLETED:
11:45 AM
NARRATIVE
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On 10/29/2024, at 10:00 AM, an informal conference was held at the Riverside Regional Office (RRO). Present in the conference were: Licensee, Ruth Gomez, and Fanny Chavez. Also present were Licensing Program Manager (LPM) Gilbert Sena, LPM Ana Noble, who translated information from English to Spanish, and Spanish to English, and Licensing Program Analyst (LPA) Aman Lama.

The Purpose of the meeting is to review and discuss the following:
  • Infant Safe Sleep Regulations
  • Children's Safe Sleep Regulations
  • Reporting Requirements
  • Licensees’ Pending Increase of Capacity Application
  • Licensee Responsibility
  • Technical Support Program (TSP)
  • Alterations to the home
  • Criminal Record Clearance
Licensee was advised to visit the Department's website at:
https://cdss.ca.gov/inforesources/child-care-licensing/resources-for-providers

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensing related information to licensed facilities, visit the CCLD Important Information website at:

https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.


(cont. 809-C)
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GOMEZ FAMILY CHILD CARE
FACILITY NUMBER: 364842823
VISIT DATE: 10/29/2024
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As a result of this informal conference, Licensee, Ruth Gomez understand the department’s expectations regarding licensees’ presence at the facility, Infant Safe Sleep, Children's Personal Rights, Reporting Requirements, TSP, and agree to maintain substantial compliance with Title 22 Regulations.

LPA Lama informed Licensee to provide a copy of this licensing report dated 10/29/2024 to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care and to any newly enrolled children's parents/guardians for the next 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A copy of this report must be available to the public for the next 3 years.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024
LIC809 (FAS) - (06/04)
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